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Weeks after Hurricanes Irma and Maria devastated the island of Puerto Rico, I had the privilege of speaking with Dr. Nabal Bracero, ACOG’s Puerto Rico section chair, at the Annual ACOG District IV Meeting in Charlotte, North Carolina. It was an opportunity to discuss the immense challenges patients and the medical community are currently facing but also to answer the question many ACOG members have been asking—“What can we do to help?”

The news stories about the recovery effort have been grim. While things are slowly getting better, 84 percent of the island is still without power, 40 percent lacks running water and the death toll has been steadily increasing—now at 43. A portion is attributed directly to the storms, however many deaths are now a result of the developing medical crisis in the storms’ aftermath. While it’s been reported that 98 percent of hospitals are currently open, including Puerto Rico Medical Center in San Juan, a majority are low on medication and medical supplies, inhibiting the quality and level of care they can provide. And patients, particularly those in critical condition that rely on ventilators, fetal heart rate monitors and other life-saving equipment, are dying due the lack of fuel to keep the generators running. In my conversation with Dr. Bracero, he said the medical center is managing but, like many hospitals, they are at capacity which limits their ability to accept new patients.

The lack of communication channels and resources, led to a conversation about how pregnant patients are faring and gaining access to needed medical services. According to Dr. Bracero, there are thousands of women at provisional sites that are in very poor conditions. These women will not be able to visit a doctor in the near term and there is no system to link ob-gyns outside of the metro areas with physicians at larger medical centers. For the patients that are in the vicinity of a provider, old-fashioned word of mouth has been the main mode of communication. Dr. Bracero said many patients simply made the trip to the office to find out if they were open. However, the section has also been working closely with ACOG to send email blasts to members in Puerto Rico to get a more comprehensive list of hospital units and offices that are open. Dr. Bracero plans to communicate that information via social media or main stream media outlets to let patients know where they can go for ob-gyn care.

ACOG has been working with CREOG and ABOG leadership, as well, on behalf of the medical students and residents in Puerto Rico to secure deadline extensions for applicants until they are able to gain access to adequate electronic communications. There is also a need to work with residency programs to potentially find alternate opportunities for residents who may be unable to complete the gynecology portion of their training programs on the island. However, Dr. Bracero pointed out that junior fellows were among the first responders with regard to ob-gyn care. Junior fellows from Districts I and IV here on the mainland have been eager to help in their own way and have started a fundraiser to help raise money for the residents of Puerto Rico.

But looking at the bigger picture, Dr. Bracero pointed out that there is still a need to do more and medical care will continue to be a top priority. There is a long road to recovery ahead and it will require advocacy, not just in our individual communities but in the nation’s Capital.